Suicide after reception into prison: A case-control study examining differences in early and late events

Abstract

Objective: Prisoners constitute a high-risk group for suicide, with suicide rates about 5 to 8 times higher than in the general population. The first weeks of imprisonment are a particularly vulnerable time, but there is limited knowledge about the risk factors for either early or late suicide events.

Methods: Based on a national total sample of prison suicides in Germany between 2005 and 2017, suicides within the first 2 (4 and 8) weeks after reception into prison were matched by age and penalty length with cases that occurred later. Factors that potentially influence the timing of suicide were investigated.

Results: The study has shown that 16.7% (31.5%) of all 390 suicides in German prisons occurred within the first two weeks (two months) of imprisonment. Factors that facilitate adaptation to the prison environment (e.g. prior prison experience) were negatively associated with early suicide events. Factors that hindered the adaptation process (e.g. withdrawal from illicit drugs) were observed more frequently in early suicide events than in late ones. These factors are active at different times of imprisonment.

Conclusion: At reception, particular attention should be paid to the following factors associated with early suicide events: widowed marital status, lack of prison experience, and drug dependency.

Fig 1. Characteristics of the matching procedure.

For each time point examined (14 days, 28 days, and 60 days after entering imprisonment), a group of early (GE) and late suicide (GL) events were matched according to age and penalty length, resulting in three pairs (GE14/GL14; GE28/GL28; GE60/GE60). For each group, box and whisker graphs are given, representing minimum and maximum values, 25th/75th percentiles, and mean values.

Fig 2. Timing of suicide events.

Scatterplot of all suicide events that occurred within the first 1500 days of imprisonment (above) and the corresponding survival curve (below). On the X-axis, additional ticks indicate days 28 and 60 of imprisonment. Vertical lines mark the median (bold line) and the 25th/75th percentile of penalty length (dotted lines).